=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073115796
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FINLEY J LOSCH MA, LCMHC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2020
-----------------------------------------------------
Last Update Date | 11/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 70 S WINOOSKI AVE STE 2B
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05401-3969
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-377-7810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 375 NORTH AVE APT 401
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05401-2953
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-377-7810
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 068.0134264
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------